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Psychological Outcomes in Long-Term Survivors of Childhood Brain Cancer: A Report From the Childhood Cancer Survivor Study

From the University of Southern California School of Social Work; the Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; the Department of Pediatrics, University of Minnesota, Minneapolis, MN; the University of Texas Southwestern Medical Center, Dallas; Texas Children's Hospital, Houston, TX; the University of Washington, Seattle, WA; the Departments of Neurology and Pediatrics, Children's National Medical Center; The George Washington University, Washington, DC; and the Department of Pediatrics, School of Medicine, University of Alabama, Birmingham, AL

Address reprint requests to Brad Zebrack, PhD, USC School of Social Work, 669 W 34th St, Los Angeles, CA 90089-0411; e-mail: zebrack{at}usc.edu

PURPOSE: To evaluate and compare psychological outcomes in long-term survivors of pediatric brain cancer and siblings of childhood cancer survivors, and to identify significant correlates of psychological distress.

METHODS: One thousand one hundred one adult survivors of childhood brain cancer and 2,817 siblings completed a long-term follow-up questionnaire allowing assessment of symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information.

RESULTS: A large majority of siblings and survivors report few, if any, symptoms of psychological distress. The prevalence of distress approximating clinically significant levels for both survivors (11%) and siblings (5%) reflects rates found in the general population. Yet when accounting for significant sociodemographic, socioeconomic, and health-status variables, survivors of childhood brain cancer, in the aggregate, appear to report significantly higher global distress and depression scores than do siblings. As in the general population, higher levels of distress among survivors and siblings were associated with female sex, low household income, lower educational attainment, being unmarried, not being employed in the past 12 months, and poor physical health status. No diagnostic or treatment-related variables were directly and significantly associated with increases in distress symptoms for survivors of childhood brain cancer.

CONCLUSION: Cancer treatment does not appear to contribute directly to increased psychological distress. Instead, distress appears to be associated with diminished social functioning that may be related to cancer type or treatment. Implementation and evaluation of supportive interventions that enhance survivors' social and vocational skills should be considered.

Supported by the National Cancer Institute of the National Institutes of Health (grant U24 CA55727) and the Children's Cancer Research Fund (L.L.R.); by the Lance Armstrong Foundation (L.K.Z.); and by a National Research Service Award (F32 CA89875-02, to B.J.Z.)

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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